3 Questions You Should Ask If You Are Experiencing Pain During Sex

Lots of women experience pain with sex at some stage in their lives. You don’t have to put up with it, and there are often several treatments available for the specific problem that you have. Remember that pain, irritation, abnormal vaginal discharge or bleeding are not normal and you should seek medical advice if you have any of these symptoms.

Here are some of the causes of painful sex that we most commonly see in our physiotherapy practice:

1. Do you have low oestrogen?

Oestrogen is the primary hormone that keeps your vagina healthy. If your body is not producing enough of it, there is less blood flow to the tissues in your pelvic area. You may experience vaginal itching, burning discomfort or stinging pain that is made worse by the friction involved in sexual intercourse. Your vagina usually responds to sexual arousal and sex itself by becoming lubricated, and by getting longer and wider (yep, amazing stuff). If you don’t have enough oestrogen, you may feel like your mind is feeling sexy but your body can’t get there! Due to the fragility of the vaginal skin, your may also have small abrasions and bleeding after sex.

Breastfeeding women, menopausal and post-menopausal women, and women who have had their ovaries removed or had radiation therapy to the pelvic area are all at risk of low oestrogen.

Personal lubricants may help if the problem is less severe. You can also get over-the-counter vaginal moisturisers, which you use every few days to help with dryness.

Talk to your doctor about whether a topical treatment may be appropriate for you. The oestrogen in these treatments is delivered in a small pill, cream or gel that is inserted into the vagina or sometimes just applied to the sore external areas. It usually takes a few weeks to get see significant changes. Your doctor will be able to advise you about the specific risks and benefits of using topical oestrogen, as they apply to you.

2. Do you have tight pelvic floor muscles?

Your pelvic floor muscles can become tight for a number of reasons. Perhaps penetrative sex has always been uncomfortable, or perhaps you’ve only noticed the problem since resuming sex after the birth of a baby. Tight muscles will often ache for some time, ever hours, after you have had uncomfortable sex.

Most often, the brain and body have developed a ‘habit’ or pattern of overactivity that makes is difficult for you to ‘switch off’ all or part of the pelvic floor. During the birth of a baby, you may have had a skin or muscle tear, an episiotomy, bruising or abrasions around the vaginal opening. Pain causes muscles to tense up, and sometimes the habit sticks around. This can also be the case if you have experienced sexual or other trauma in the past.

Pregnancy changes your posture – a lot. The pelvic floor muscles can become tight in the postnatal period because your postural and muscular control hasn’t gone back to normal. Your hip joint is very close to the pelvic floor, and so hip or lower back pain can be a symptom of overactive pelvic floor muscles. If your tummy muscles haven’t recovered properly, your pelvic floor may be trying to do more to compensate.

Whether your tight pelvic floor is a new problem or a longstanding one, research has demonstrated that pelvic floor physiotherapy is an effective way of treating it. You don’t need a GP referral to see a Women’s Health and Continence Physiotherapist, you can just call and make an appointment. Physios are also trained to know when your problem is not appropriate for us to treat. (NB: Don’t ask your general or sports physio to help you with this one! You need a physio with special training in pelvic floor assessment and management.)

3. Do you have a pelvic organ prolapse?

Women with prolapse will often say that there’s ‘something in the way’ when they try to have sex. Sometimes they describe a deep, thudding discomfort that is worse with ‘woman on top’ positions.

These symptoms can occur when one or more of your bladder, uterus, or bowel have moved lower inside your pelvis. Other symptoms or prolapse include urinary or bowel incontinence, bladder urgency, trouble emptying bladder or bowel, dragging lower back pain, or a feeling of something coming down inside the vagina. Some women can feel or see a pinkish bulge there.

If you suspect a prolapse is the cause of your discomfort, seek advice from your GP or from an experienced Women’s Health and Continence Physiotherapist. Physio has been proven to be effective to decrease the symptoms of prolapse, and may reverse the severity of the condition. Your physio can teach you about managing your prolapse, and show you how to correctly activate and strengthen your pelvic floor muscles to stop it getting worse. She can give you guidance about safe general exercise and lifting.

Finally, if you have any questions about this article or anything else pelvic floor related, please get in touch with us on 9416 4410 or email physio@sydneyadvancedphysio.com.au to directly contact the physios.

Author: Claire Dunn (Women’s Health Physiotherapist)

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